Increased Risk of Suicide Associated With Acute Coronary Syndrome

Acute coronary syndrome (ACS) patients are at an increased risk of suicide compared to otherwise healthy people, with the risk of suicide particularly high in the 6 months after ACS diagnosis, according to a new study.

“Although depression and its association with cardiac disease have been extensively investigated, to our best knowledge, prior studies have not reported the association between ACS and suicide after adjusting for diabetes mellitus, stroke, chronic kidney disease, and psychiatric illness,” the researchers said.
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In this case-referent study conducted in Taiwan, the investigators used cases of people age 35 or older who died from suicide between 2000 and 2012 and 4 live referents, each matched by age, sex, and area of residence. They adjusted for sociodemographic characteristics, physical comorbidities, and psychiatric disorders and identified 41,050 people who committed suicide and 164,200 referents.

In the case and referent groups, 1027 (2.5%) and 2412 (1.5%) patients had ACS, respectively. After adjusting for potential confounders, ACS was significantly associated with increased odds of suicide (adjusted odd ratio=1.15). The investigators found odds of suicide highest during the initial 6 months post-ACS diagnosis (odds ratio=3.05) and remained high for at least 4 years after ACS diagnosis.

“Our results support the recommendation that screening for depression and suicidal ideation should be conducted for all patients with ACS, particularly in the early stage of new diagnosis,” the researchers concluded.

They said future studies should recruit large samples of participants to make evident the effectiveness of managing mental illness in general and depression in particular to improve various outcomes of ACS, including suicide mortality.

“Our research team plans to continue to investigate which parts of life are most unbearable after the ACS diagnosis, as well as what kinds of needs, support, and assistance they need to cope with such a devastating disease,” said study author Jung-Chen Chang, PhD, assistant professor in the school of nursing at National Taiwan University in Taipei. “ACS is not immediately fatal and can be considered a manageable condition. Patients should keep an optimistic attitude and not reject constructive treatment, such as PCI and CABG.”

—Mike Bederka

Reference:

Liu C-H, Yeh M-K, Wang J-H, et al. Acute coronary syndrome and suicide: a case-referent study [published online Dec. 7, 2016]. J Am Heart Assoc. doi:10.1161/JAHA.116.003998.